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  • YOUR HEALTH. IN FOCUS .

    MRI & CT Indication Guidelines

    compliments of Premier Radiology

  • SERVICES for Patients and Physicians

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  • The information provided in this guide is not intended to be a substitute for a licensed radiologists recommendation.The material provided is strictly an informational guideline for the most probable scan ordered. Specific questionsshould be directed to our radiology group or our imaging technician. Our radiologists reserve the right to recommend an alternative scan based on a patients clinical history and diagnosis provided by the referring physician.

    MRI & CTIndication Guidelines

    1

    ABDOMEN& PElviS

    Clinical Problem Preferred Contrast Comments(Abdomen & Pelvis) study

    non-focal Pain

    Appendicitis,diverticulitis

    Painful Hematuria, r/o kidney stone

    Painless HematuriaRenal mass

    liver mass

    bile duct stoneor obstruction

    Aortic Aneurysm

    CT Abdomen

    CT Abdomenand Pelvis

    CT Abdomenand Pelvis

    CT Abdomenwith and w/oIV contrast; consider MR with and w/o contrast if CT indeterminate

    MR

    MR

    CT

    Oral and IV contrast

    Oral and IV contrast

    Yes

    Yes

    No

    Yes

    IV needed for solid organ disease

    IV contrast helpful if patient is thin

    Evaluation for renal stone

    Useful for indeterminate renal cysts/lesions on Ultrasound

    Eovist contrast is best

    Request MR Cholangiopancreatography(MRCP)

  • The information provided in this guide is not intended to be a substitute for a licensed radiologists recommendation.The material provided is strictly an informational guideline for the most probable scan ordered. Specific questionsshould be directed to our radiology group or our imaging technician. Our radiologists reserve the right to recommend an alternative scan based on a patients clinical history and diagnosis provided by the referring physician.

    Clinical Problem Preferred Contrast Comments(Abdomen & Pelvis) study

    Cancer Patient

    AdrenalGland

    Pelvis-Female

    Pelvis-male

    CT Abdomenand Pelvis with contrast;

    CT Abdomenwithout,contrast ifneeded afternon-contrastCT per radiologist

    Ultrasound,then MR>CT

    CT or MR

    Oral and IVContrast

    Non-contrastmay be sufficient. no oral contrast

    CT: oral andsometimes IV contrast

    CT: oral andsometimes IV contrast

    Contrast only if non-contrast CT is inconclusive

    ABDOMEN& PElviS

    MRI & CTIndication Guidelines

    2

  • > recommended over other study>> strongly recommended over other study

    The information provided in this guide is not intended to be a substitute for a licensed radiologists recommendation.The material provided is strictly an informational guideline for the most probable scan ordered. Specific questionsshould be directed to our radiology group or our imaging technician. Our radiologists reserve the right to recommend an alternative scan based on a patients clinical history and diagnosis provided by the referring physician.

    BRAIN

    MRI & CTIndication Guidelines

    3

    Clinical Problem Preferred Contrast Comments(bRAin) study

    CvA

    Acute bleed

    subarachnoidbleed

    brain Tumor,metastases

    seizure

    Cns infection,Abcess, meningitis

    Aids

    Headache

    dementia

    neurodegenerativedisorder

    Carotid stenosis

    CT (0-24hrs)MR

    CT>>MR

    CT

    MR>>CT

    MR

    MR

    MR

    MR

    MR>CT

    MR

    CTA

    NoNo

    No

    No

    Yes

    Yes

    Yes

    Yes

    No

    No

    No

    Yes

    If less than 6 hours, also consider CTA or MRA of neck and brain. If less than 24 hours, referral to ER/Acute care facility for imaging is usually preferred

    CT better for tumorcalcification

    Contrast for adults first time seizure, especially if over 40

    Contrast for meningeal/dural disease, mass, meningioma

    MR gives superior evaluation of white matter changes, patterns of atrophy

    Parkinsons disease, etc.

  • > recommended over other study>> strongly recommended over other study

    The information provided in this guide is not intended to be a substitute for a licensed radiologists recommendation.The material provided is strictly an informational guideline for the most probable scan ordered. Specific questionsshould be directed to our radiology group or our imaging technician. Our radiologists reserve the right to recommend an alternative scan based on a patients clinical history and diagnosis provided by the referring physician.

    BRAIN

    MRI & CTIndication Guidelines

    4

    Clinical Problem Preferred Contrast Comments(sPine) study

    subduralHematoma

    ms

    Posterior Fossa,brainstem lesion

    Acoustic neuroma,sensorineuralHearing loss

    PituitaryTumor

    PulsatileTinnitus

    Aneurysm

    venous sinusThrombosis

    CT= MR

    MR

    MR

    MR

    MR

    MR>CT

    MRA or

    CTA

    CTA=MR/MRV

    NoNo

    Yes

    Yes

    Yes

    Yes

    Yes

    Possibly

    Yes

    No

    MR detects smaller non-surgical acute SDH and Sub-acute to chronic SDH

    Contrast helpful if non-contrast is abnormal

    MR far superior in this region

    CT not sensitive for small IAC lesions but may be needed for otic capsule disease

    MR far superior in this region

    MRA neck and/or brainsometimes helpful

    MRA for screeningespecially at high fieldCTA for greater detail

    Usually can avoidconventional Venography

  • CHEST

    MRI & CTIndication Guidelines

    5

    The information provided in this guide is not intended to be a substitute for a licensed radiologists recommendation.The material provided is strictly an informational guideline for the most probable scan ordered. Specific questionsshould be directed to our radiology group or our imaging technician. Our radiologists reserve the right to recommend an alternative scan based on a patients clinical history and diagnosis provided by the referring physician.

    Clinical Problem Preferred Contrast Comments(CHesT) study

    Pulmonaryembolus

    nodule, mass,infiltrate

    inerstitual lungdisease

    Coronary Arterydisease

    Coronary Calcium screening

    Aortic Aneurysmdisease

    CTA

    CT

    HighResolution CT

    CT of Heart

    CT

    Yes

    Yes or No

    No

    Yes

    No

    Yes

    Evaluation of acute chestpain and SOB

    Peripheral nodules remote from hilum can be imaged without contrast. Contrast helpful for hilar disease

    1 or 2 mm slices at5 or 10 mm increments

    Detailed visualization ofcoronary arteries

    Screening for people with low to moderate risk of CAD

  • NECKSKull, BASE& ORBIT

    MRI & CTIndication Guidelines

    6

    = comparable studies> Recommended over other study>> strongly recommended over other study

    Clinical Problem Preferred Contrast Comments(Neck, Skull, BaSe & OrBit) study

    sinusitis

    neck mass

    ConductiveHearing loss-sesorineural Hearing loss-

    skull base

    squamous CA

    vocal Cord Paralysis

    orbit-Proptosis

    optic nerves

    Cavernous sinus

    Cranial nerves

    Facial Trauma

    salivary Gland

    CT

    CT>MR

    CT

    MR

    MR = CT

    CT>MR

    CT>>MR

    CT or MR

    MR>>CT

    MR

    MR

    CT

    CT

    No

    Yes

    No

    Yes

    Yes

    Yes

    Yes

    Yes

    Yes

    Yes

    Yes

    No

    Yes

    CT defines ostial obstructionBone changes

    Adenopathy better on CT; Tongue and perineural skull base disease better on MR

    Mastoid, middle ear, ossicles

    IAC, brainstem/CPA,Labyrinth

    CT sometimes necessary to better show bony detail

    Skull base to thoracic inlet

    Skull base to carina

    No contrast for Graves disease

    MR - optic neuritis,high field works bestCT - Meningioma, calcification

    MR brain/sella

  • SPiNE

    MRI & CTIndication Guidelines

    7

    > recommended over other study>> strongly recommended over other study

    The information provided in this guide is not intended to be a substitute for a licensed radiologists recommendation.The material provided is strictly an informational guideline for the most probable scan ordered. Specific questionsshould be directed to our radiology group or our imaging technician. Our radiologists reserve the right to recommend an alternative scan based on a patients clinical history and diagnosis provided by the referring physician.

    Clinical Problem Preferred Contrast Comments(sPine) study

    Herniated disc, Cervical or Thoracic, lumbar

    stenosis

    discitis/ osteomyelitis

    metastasis: bone

    epidural or intraspinal

    Compression Fracture, bone metastasis

    Cord disease

    Cord Tumor

    MR>>CT

    MR>>CT

    MR

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